A Web-Based Data Warehouse

The Elizabeth Glaser Pediatric AIDS Foundation seeks to prevent the disease from ravaging the next generation of children in poor countries by financing HIV tests and treatment for women and children in Africa, Asia, and elsewhere.

For most of the charity’s history, information about the thousands of women and children the foundation serves each year was sent by e-mail or fax to its Washington headquarters or dictated over the phone, says Mark Reilly, director of information technology at the organization.

Mr. Reilly says a staff member named Chuck Hoblitzelle, senior technical officer in the organization’s Los Angeles office, manually entered the data into a FileMaker database. None of the other staff members had access to the database, so if they had a question about the effects of the foundation’s services, he says, staff members had to “call Chuck,” and they couldn’t expect an immediate response. “If our CEO needed the information, and I needed the information, who do you think got it first?” Mr. Reilly asks.

And because the numbers often were re-entered several times en route to Chuck’s database, he says, raising the likelihood of human error, the information was not always reliable.

So when Sara Pacqué-Margolis arrived in March 2006 as the foundation’s new director of monitoring and evaluation, she says, “I knew the first thing I would have to do is develop a Web-based data warehouse.”

The foundation needed a way to track — and learn how it might improve — its effectiveness in preventing and treating HIV and AIDS, she says.

The challenge, Ms. Pacqué-Margolis and Mr. Reilly say, was to design an affordable system that could provide accurate, standardized data while overcoming the hurdles of slow Internet connections, frequent power outages, and limited technology expertise that are common in many of the countries in which the foundation works.

Rapid Growth

Founded in 1988 in Los Angeles as the Pediatric AIDS Foundation, by the activist Elizabeth Glaser, a mother who unknowingly contracted HIV from a blood transfusion and transmitted it to her children (and who died in 1994), the charity initially focused on advocating for and sponsoring research on mother-to-child transmission of HIV. In 1999, the organization started its grass-roots efforts to prevent newborns in developing nations from becoming infected with HIV, with $1-million donated by private sources. The following year, the foundation received $15-million from the Bill & Melinda Gates Foundation to continue that work.

Those first steps led to a windfall in 2003, when the foundation won a five-year, $100-million contract from the U.S. Agency for International Development to expand its efforts. The following year, the charity won another five-year federal contract, this time $125-million from the Centers for Disease Control and Prevention, to provide care and treatment services in four African nations. Both financing arrangements have been renewed.The charity’s annual budget is $101-million, according to Robert Yule, its media manager.

At the time of Ms. Pacqué-Margolis arrival she says, the foundation’s tracking systems simply had not caught up with the scope of its work.

A Flexible System

To design its new Web-based tracking system, called the Global AIDS System for Evaluation and Reporting (which goes by Glaser), the charity worked with Acumen Solutions, a business and technology consulting firm in Vienna, Va.

The accuracy of the foundation’s data on its work has improved since the system, which cost $2-million to develop, went online in June 2007, Mr. Reilly says, because information is automatically cross-checked. For instance, if a staff member reports that 100 women were tested for HIV and 110 tested positive, Glaser will spot the error and require the data to be re-entered. In addition, he says, all newly entered data is reviewed twice: by people working overseas and by the Washington headquarters.

Knowing that the conditions in which staff members abroad work differ greatly from the foundation’s offices in downtown Washington, Mr. Reilly and his colleagues designed the system to be flexible, he says, anticipating the need for changes.

Several important changes were made soon after Glaser’s prototype was tested in Swaziland, Tanzania, and South Africa in February 2007. Originally, staff members outside the United States entered data into the system. The page where they placed the data was designed to look like an Excel spreadsheet, Mr. Reilly says, because many of the foundation’s employees already submitted data in that format. But sluggish Internet connections and frequent power outages meant staff members often lost their work in the middle of entering data. Before Glaser’s full-scale start, the system’s designers made it possible for the workers to enter data offline, into Excel spreadsheets customized for each country, and upload them into the system.

The designers also realized that overseas workers needed to be able to enter information from more than one clinic into one spreadsheet, says Kevin Bahumian, one of the consultants from Acumen Solutions. “Tanzania has 600 sites,” he says. “That’s a lot of Excel spreadsheets if you think about it.”

During Glaser’s development, Mr. Reilly says, the design was tweaked to create smaller screen images that loaded faster, and to make training in foreign languages easier. The beginning of this year brought more improvements, including forms reformatted to load faster and be easier to navigate, new reports showing country-specific information, and auditing tools that let administrators track who changed what data.

Emmanuel Anyachebelu, a monitoring and evaluation officer in the foundation’s office in Johannesburg, says that since these most recent upgrades, he has spent less time loading Glaser on his computer and more time double-checking his data.

The charity’s willingness to deal with obstacles and make incremental changes impressed NPower Greater DC Region, which in 2008 gave the foundation its Technology Innovation Award, says Julie Chapman, president of the nonprofit technology provider. “They focused on what they wanted to do and how technology could get them there, and then they were very realistic when they encountered problems,” she says.

‘We See the Forest’

Foundation staff members say the improvements in data collection and tracking are aiding the charity’s prevention and treatment work, its efforts to influence HIV-treatment policy in the countries in which it works, and its ability to report on the effectiveness of its work to the governments and nonprofit organizations it works with abroad, as well as its benefactors at home.

The foundation’s monitoring and evaluation staff members say the Glaser system helps them to identify trends in patient data, which the clinics they support don’t have the time, tools, or the staff to see.

“They see the trees, and we see the forest,” says Shoba Ramachandran, a monitoring and evaluation officer for South Africa, who works in the charity’s Washington office. “Without Glaser, we wouldn’t be able to provide that for them.”

Ms. Pacqué-Margolis says using information gleaned from Glaser, the foundation has influenced several countries’ decision to allow clinics to give women the antiretroviral drug Nevirapine to take home with them after their first visit. Many women who went to the clinics early in their pregnancies but didn’t return never got the pill, which was commonly prescribed later in pregnancy to prevent mother-to-child transmission of the virus, she says.

“We were able to show them all of the women who don’t come back,” she says.

In the United States, where more and more private and corporate grant makers want to know that their charitable dollars are being used wisely, one corporate supporter of the Glaser Foundation sees Glaser as a valuable enhancement to the group’s work.

“With all of our grantees, we look really carefully at who are they reaching, and the programs that they are delivering, how are they being received,” says Anu Gupta, a corporate giving officer at Johnson & Johnson, in New Brunswick, N.J. The company has supported the Glaser foundation’s efforts to prevent mother-to-child transmission of HIV, giving a total of $9-million since 1991.

Ms. Gupta says the Glaser system gives Johnson & Johnson a picture of the number of women the charity is reaching, and it also gives both organizations a better sense of the challenges they face in their efforts to increase women’s access to screening and preventive medicines that will keep them from giving AIDS to their children.

The most important use the system will have, Ms. Pacqué-Margolis says, is enabling the foundation to continue to improve the services it provides to HIV-positive women and their babies in developing nations.

“We need to do better and not just assume what we’re doing is right,” she says. “You just can’t spend millions of dollars without looking at how it’s working.”